肝纤维化分期和谷氨酸脱羧酶抗体在肝源性糖尿病中的诊断价值

探讨肝纤维化程度分期和谷氨酸脱羧酶抗体在慢性乙型肝炎（慢乙肝）并发肝源性糖尿病中的诊断价值。对75例慢乙肝和肝硬化合并糖尿病患者分别进行空腹、服糖后2h血浆血糖、胰岛素、C肽和谷氨酸脱羧酶抗体（GADA）测定，对慢乙肝患者进行肝组织病理检查，按肝纤维化程度分期。结果乙肝肝硬化并发肝源性糖尿病患者的BMI值较乙肝肝硬化合并糖尿病患者的低。慢乙肝合并糖尿病S≥3组空腹、餐后2h血糖、胰岛素、C肽、GADA的阳性率以及糖尿病症状、空腹低血糖发生率与乙肝肝硬化并发肝源性糖尿病组比较差异无统计学意义（P〉0．05）；慢乙肝合并糖尿病S≥3组空腹、餐后2h胰岛素、c肽和与慢乙肝血糖正常S≥3组比较差异无统计学意义（P〉0．05），而GADA的阳性率显著升高，两组之间的差异具有统计学意义（χ^2=4．713，P〈0．05）。结论肝纤维化程度S≥3和谷氨酸脱羧酶抗体阳性有助于慢乙肝并发肝源性糖尿病的诊断。

The Diagnostic Value of the Stage of Liver Fibrosis and Glutamic Acid Decarboxylase Antibody in Hepatogenic Diabetics

To investigate the diagnostic value of the stage of liver fibrosis and Glutamic Acid Decarboxylase Antibody （GADA） in patients of chronic hepatitis B with hepatogenic diabetes. 75 cases of chronic hepatitis B or liver cirrhosis patients were tested for the fasting and 2--hour postprandial plasma glucose, insulin, C--peptide and GADA. The stage of liver fibrosis was examined by liver biopsy in patients with chronic hepatitis B. The BMI for patients of hepatitis B liver cirrhosis with hepatogenic diabetes is less than that of chronic hepatitis B with diabetes. The fasting and 2--hour postprandial plasma glucose, insulin,C--peptide ,the rate of GADA positive, symptom of diabetes and the incidences of fasting hypoglycemia had no significant difference between the group of S≥3 patients of chronic hepatitis B with diabetes and the group of patients of hepatitis B liver cirrhosis with hepatogenic diabetes（ P〉0.05）. The fasting and 2--hour postprandial plasma insulin, C--peptide had no significant difference between the group of S≥3 patients of chronic hepatitis B with diabetes and the group of S≥3 patients of chronic hepatitis B with euglycemia（P〉0.05）, but their rate of GADA positive had significant difference between the two groups（ χ^2= 4. 713,P〈0.05）. Both stage of liver fibrosis S≥3 and GADA positive had a definite clinical value in the diagnosis of hepatogenic diabetes in the patients of chronic hepatitis B.